Hypertension (HTN) is a chronic medical condition characterized by persistently elevated arterial blood pressure, typically defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg in adults. It is a major modifiable risk factor for cardiovascular disease, stroke, renal failure, and premature mortality worldwide. ^[1,2] Hypertension contributes substantially to the global burden of disease and disability, causing an estimated 7.5 million deaths annually, which represents about 12.8% of all deaths and significant disability adjusted life years (DALYs).^[3]

Globally, hypertension affects a substantial proportion of adults, with the overall prevalence in adults estimated at around 40% in early 21st century surveys.^[3] Recent national surveys in India estimate the prevalence of hypertension at approximately 22–27% among adults, with higher rates in urban populations and increasing prevalence with age.^[4,5] Hypertension may be classified based on etiology and clinical context into primary (essential) hypertension, which accounts for most cases and has no identifiable cause, and secondary hypertension, resulting from underlying conditions such as renal disease, endocrine disorders, or medication effects. ^[1] Clinically, it is also graded into stages (e.g., Stage I, Stage II) depending on blood pressure levels and risk profile, guiding treatment strategies.

Management of hypertension includes both non-pharmacological interventions (lifestyle modification) and pharmacotherapy. Antihypertensive drug classes widely used in clinical practice include thiazide and thiazide-like diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), alpha-blockers, and various combination formulations. First-line agents often include thiazide diuretics, ACE inhibitors or ARBs, and CCBs, depending on patient comorbidities and guideline recommendations. ^[1]

Pharmacoeconomic studies evaluate the financial implications of drug therapies, particularly cost variation between different brands of the same antihypertensive agents. In India, research has shown substantial cost variation among brands of commonly prescribed antihypertensive drugs, with percentage cost differences often exceeding 100% and, in some cases, reaching high multiples, highlighting potential economic burdens on patients. ^[6,7] Despite the chronicity of hypertension and need for lifelong therapy, large price variations among branded versions of the same generic drug may negatively impact treatment adherence and patient outcomes. ^[6–8] However, limited pharmacoeconomic data are currently available specifically for the drug market in Jammu, where the availability and price variation may be influenced by regional factors including local distribution, pharmacy pricing, and prescribing patterns.

Jan Aushadhi generic medicines are therapeutically equivalent and bioequivalent to branded medicines but are sold at substantially lower prices because they do not include heavy marketing and promotional expenditures. The availability of low-cost generic antihypertensive medicines can significantly reduce the financial burden on patients who require lifelong therapy. ^[9] In Jammu city, multiple Jan Aushadhi Kendras are operational and supply commonly prescribed antihypertensive medicines such as amlodipine, telmisartan, losartan, atenolol, enalapril, hydrochlorothiazide, and various fixed-dose combinations. These medicines are available at considerably reduced prices compared to branded products sold in private retail pharmacies. ^[10] Since hypertension requires long-term or lifelong treatment, the cost of therapy plays a crucial role in medication adherence and overall disease control. Therefore, a pharmacoeconomic evaluation comparing the cost of Jan Aushadhi generic antihypertensive drugs with branded drugs available in the Jammu market is essential to assess potential cost savings and promote rational prescribing practices.

Understanding the cost variation among antihypertensive drug brands in the local market of Jammu is essential to inform prescribers and policymakers and promote cost-effective hypertension management.

Study Design

The present study will be a cross-sectional, observational, descriptive pharmacoeconomic study designed to evaluate the cost variation among different brands of antihypertensive drugs available in the market. The study will focus on comparing the maximum retail prices (MRP) of various brands of the same antihypertensive drug formulations marketed in identical strength and dosage forms.

Study Duration

The study will be conducted over a period of six months. During this period, data regarding drug prices will be systematically collected, compiled, and analysed.

Study Setting

The study will be conducted in retail pharmacies and wholesale drug markets within the selected study area. Drug price data will be collected from multiple private pharmacies to ensure representation of different pharmaceutical brands available in the local market.

Inclusion Criteria

• Antihypertensive drugs commonly prescribed for the management of hypertension.
• Drugs available in tablet or capsule form.
• Drugs available in identical strength and dosage form across two or more different brands.
• Both single-drug formulations and fixed-dose combinations (FDCs).
• Drugs listed under essential medicine lists and routinely available in the market.

Exclusion Criteria

• Drugs available in only one brand.
• Drugs with different strengths or dosage forms that are not directly comparable.
• Injectable antihypertensive formulations.
• Recently launched brands with limited availability in the market.
• Incomplete pricing information.

Ethical Committee Approval

The study was conducted after taking permission from institutional ethical committee protocol presented and described in the proposal vide No. IEC/GMCK/39 dated 29-05-2024.

Study Procedure

1. A list of commonly prescribed antihypertensive drugs will be prepared based on standard pharmacology textbooks, prescription trends, and essential medicines lists.
2. For each selected drug, all available brands marketed in the same strength and dosage form will be identified.
3. The Maximum Retail Price (MRP) of each brand will be recorded. Prices will be noted per 10 tablets or per strip, as applicable.
4. The highest-priced brand and lowest-priced brand for each formulation will be identified.
5. Data will be entered into Microsoft Excel for further analysis.

Cost Analysis Formulas

The following formulas will be used to determine cost variation:

1. Cost Ratio

This indicates how many times the costliest brand is more expensive than the cheapest brand.

2. Percentage Cost Variation

This represents the percentage difference in cost between the highest and lowest priced brands of the same drug.

Statistical Analysis

All the collected data will be entered into Microsoft Excel and analysed using SPSS software. The analysis will be done mainly using simple descriptive statistics. For each antihypertensive drug, the minimum price and maximum price among different brands will be recorded. The average (mean) price of all available brands will be calculated. The standard deviation will be calculated to understand how much the prices vary from the average price.

The cost ratio will be determined to show how many times the costliest brand is higher than the cheapest brand. The percentage cost variation will be calculated to show the difference in price between the highest-priced and lowest-priced brands.

The present study entitled to study the cost variation of antihypertensive drugs available in the market of different brands was conduced after taking permission from the institutional ethical committee. The table presents the distribution of 42 antihypertensive drugs under different categories. Angiotensin Receptor Blockers (ARBs) have the highest number, with 7 drugs. Calcium Channel Blockers and Beta Blockers each include 6 drugs. Angiotensin Converting Enzyme (ACE) Inhibitors consist of 5 drugs. Thiazide Diuretics include 4 drugs, while High Ceiling (Loop) Diuretics account for 3 drugs. Potassium Sparing Diuretics, Adjunctive Diuretics, Alpha + Beta Blockers, Central Sympatholytic drugs, and Sympathetic Inhibitors each have 2 drugs in their respective categories. The least represented category is α-2 Receptor Agonists, with only 1 drug.

Table 1: List and Number of Antihypertensive Drugs in Each Category as per Jan Aushadhi Drug List

Table 2: Cost Comparison of Angiotensin Receptor Blockers Available Under Jan Aushadhi and Branded Drugs

Table No 3: Cost Comparison of Calcium Channel Blockers

Table No 4 Cost Comparison of Beta Blockers

Table 5: Cost Comparison of Diuretics

Table 6 Cost Comparison of ACE Inhibitors

Table 7: Cost Comparison of Sympathetic Inhibitors

Hypertension is a major non-communicable disease requiring lifelong pharmacotherapy. Cost variation among antihypertensive drugs significantly affects medication adherence, especially in low- and middle-income countries like India. The present study analysed 42 antihypertensive drugs listed under the Jan Aushadhi scheme and compared their prices with branded equivalents. The findings demonstrate wide inter-brand and generic-brand price variations across all major therapeutic classes.

The Jan Aushadhi list included 42 antihypertensive drugs categorized into 12 pharmacological groups. The largest proportion consisted of Angiotensin Receptor Blockers (7 drugs), followed by Calcium Channel Blockers (6 drugs) and Beta Blockers (6 drugs). ACE inhibitors accounted for 5 drugs, while diuretics were represented in multiple subcategories (Thiazides – 4; Loop – 3; Potassium sparing – 2; Adjunctive – 2). This distribution mirrors contemporary hypertension guidelines that recommend RAAS inhibitors, CCBs, thiazide diuretics, and beta blockers as first-line or adjunctive therapies depending on comorbidities. The predominance of ARBs and CCBs in the list reflects their widespread clinical use and better tolerability profiles compared to older agents.

Similar therapeutic distribution patterns were reported by Gupta et al. (2019) ^[11] in their epidemiological review of hypertension management in India, where ARBs and CCBs were the most commonly prescribed classes. Additionally, the WHO Model List of Essential Medicines (2021) includes ACE inhibitors, ARBs, thiazides, and CCBs as essential antihypertensive options, supporting the rational selection observed in the Jan Aushadhi formulary.

Marked price variation was observed among ARBs. For instance, Telmisartan 40 mg showed a 500% cost difference (cost ratio 6.00), while Olmesartan 20 mg demonstrated a 308.82% difference (cost ratio 4.09). Losartan 50 mg exhibited a 296.69% difference. Even newer ARBs such as Azilsartan 40 mg showed a 75% difference. Such wide variations significantly impact long-term affordability since ARBs are commonly prescribed for patients’ intolerant to ACE inhibitors. Comparable findings were reported by Srinivasan (2011) ^[13], who highlighted excessive price dispersion among cardiovascular drugs in India. Similarly, Patel et al. (2014) ^[14] documented cost ratios exceeding 3–5 times among different brands of ARBs.

Among CCBs, Amlodipine 5 mg showed a 398.18% cost difference (cost ratio 4.98), while Cilnidipine 20 mg demonstrated a 379.80% difference. Diltiazem 90 mg also showed 151.52% variation. Interestingly, Benidipine 4 mg exhibited a negative variation (-20%), suggesting that in some instances branded drugs may be competitively priced. CCBs are among the most prescribed antihypertensive drugs globally due to their strong evidence base. High variability in pricing may adversely influence adherence. Similar findings were observed by Sharma et al. (2016), ^[15] who reported significant price variation in amlodipine brands in India. Additionally, Wanwimolruk et al. (2017) ^[16] emphasized that generic substitution improves affordability and adherence in chronic cardiovascular therapy.

Beta blockers demonstrated considerable variation. Metoprolol 50 mg showed a 495.96% cost difference (cost ratio 5.96), and Propranolol 40 mg had a 384.85% difference. Atenolol 25 mg exhibited 362.79% variation. However, Bisoprolol 5 mg showed relatively lower variation (40.91%). Such discrepancies highlight the lack of uniform price regulation across brands. Similar findings were documented by Jain et al. (2015), ^[17] who observed wide cost variation among beta blockers in India. Furthermore, Dutta et al. (2018) ^[18] emphasized the economic burden of cardiovascular drug price differences on chronic disease management.

Loop diuretics such as Torsemide 10 mg showed a 400% cost difference (cost ratio 5.00), while Torsemide 5 mg showed 302.99% variation. Hydrochlorothiazide 12.5 mg demonstrated a 105% difference, and Spironolactone 25 mg showed relatively lower variation (44.90%). Since thiazides are recommended as first-line therapy in many guidelines, even moderate price differences may affect large patient populations. Similar pharmacoeconomic findings were reported by Kumar et al. (2013) ^[19] and Shankar et al. (2016) ^[20] in Indian market analyses.

ACE inhibitors showed some of the highest price variations. Ramipril 5 mg exhibited a 696% difference (cost ratio 7.96), the highest observed in this study. Lisinopril 10 mg showed 553.59% variation, while Ramipril 2.5 mg showed 532.47% difference. Given that ACE inhibitors are widely used in hypertension, heart failure, and diabetic nephropathy, such extreme cost differences significantly affect affordability. Similar findings were documented by Patel et al. (2014) ^[14] and Srinivasan (2011), ^[13] who reported excessive price dispersion in ACE inhibitors.

Among sympathetic inhibitors, Carvedilol 20 mg showed a 511.60% difference (cost ratio 6.12), while Carvedilol 6.25 mg demonstrated 444.16% variation. Labetalol 100 mg showed 219.11% variation. Clonidine 100 mcg exhibited comparatively lower variation (81.82%). . Combination alpha-beta blockers and centrally acting agents are frequently used in resistant hypertension and pregnancy-induced hypertension. Significant price differences in these drugs may affect accessibility in tertiary care settings. Similar findings were reported by Dutta et al. (2018) ^[18] and Sharma et al. (2016) ^[15] in cardiovascular drug price analyses.

This study compared the cost of 42 antihypertensive drugs across different categories. The highest number of drugs were found in Angiotensin Receptor Blockers, Calcium Channel Blockers, and Beta Blockers, showing that many treatment options are available for managing hypertension. The results clearly show that Jan Aushadhi generic medicines are much cheaper than branded medicines in almost all categories. In many cases, branded drugs cost 2 to 6 times more than generics. For some medicines like Ramipril, Lisinopril, Telmisartan (40 mg), and Torsemide (10 mg), the price difference was even higher. Although a few medicines showed small differences in price, the overall trend strongly favors Jan Aushadhi generics as a more affordable option. Therefore, using generic medicines can significantly reduce treatment costs, improve patient compliance, and lessen the financial burden of long-term hypertension management

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